Delayed discharge from hospital: supporting older people to exercise choice

Abstract

The government's reimbursement policy, whereby local councils face fines if a patient cannot be discharged from hospital because they are waiting for an assessment etc, introduced new pressures into a system that was already fraught. One of the policy's aims is to allow people to exercise ‘genuine choice’ as regards their ongoing and longer-term care. Based on their research into the policy however, Michelle Cornes et al investigate whether choice really can be exercised when lying in a hospital bed

Impact and experiences of delayed discharge: A mixed‐studies systematic review

“…*Two studies provided data on costs and quantitative variables . † Three papers reported data from one study…”

“…Delays in discharge affected patients’ emotional state. Hospitals were considered poor environments for a protracted stay because wards could be noisy even at night, they lack personal privacy and they limit patients’ autonomy . A knock‐on effect of delayed discharge was pressure on hospitals to expedite other patients’ discharge.…”

“…Patients expressed anxiety and other negative feelings about delays. Emotional outcomes of delay included tedium or boredom, depression and loss of independence . One elderly patient awaiting assessment on a stroke rehabilitation ward communicated a sense of desperation and reported being “so low” due to not knowing when they could leave hospital …”

“…Due to a lack of movement and loss of independence, patients expressed concern about deterioration in their general health while in hospital and an increased risk of bed sores . Patients also reported that pressure to discharge them due to bed shortages meant that they had not recovered sufficiently prior to discharge and that their needs had not been addressed effectively .…”

“…Discharge delays caused stress for staff for several reasons: they lengthened waiting lists (which the staff had responsibility to reduce) and created pressure for some patients to be discharged home, which in turn created frustration and guilt among staff who felt patients were being pressured to leave hospital . The strong management focus on reducing delayed discharges made staff feel “under the cosh” and adversely affected interprofessional relationships. The consultants and managers concerned with achieving government targets were most likely to pressure other staff to discharge patients and to become “disillusioned” about their care role because they were preoccupied with discharging patients, rather than providing care to those in need …”